title: Postoperative subconjunctival bevacizumab injection as an adjunct to 5-fluorouracil in the management of scarring after trabeculectomy.
abstract: OBJECTIVE
  Scarring after glaucoma filtering surgery remains the most frequent cause for bleb failure. The aim of this study was to assess if the postoperative injection of bevacizumab reduces the number of postoperative subconjunctival 5-fluorouracil (5-FU) injections. Further, the effect of bevacizumab as an adjunct to 5-FU on the intraocular pressure (IOP) outcome, bleb morphology, postoperative medications, and complications was evaluated.
  
  
  METHODS
  Glaucoma patients (N = 61) who underwent trabeculectomy with mitomycin C were analyzed retrospectively (follow-up period of 25 ± 19 months). Surgery was performed exclusively by one experienced glaucoma specialist using a standardized technique. Patients in group 1 received subconjunctival applications of 5-FU postoperatively. Patients in group 2 received 5-FU and subconjunctival injection of bevacizumab.
  
  
  RESULTS
  Group 1 had 6.4 ± 3.3 (0-15) (mean ± standard deviation and range, respectively) 5-FU injections. Group 2 had 4.0 ± 2.8 (0-12) (mean ± standard deviation and range, respectively) 5-FU injections. The added injection of bevacizumab significantly reduced the mean number of 5-FU injections by 2.4 ± 3.08 (P ≤ 0.005). There was no significantly lower IOP in group 2 when compared to group 1. A significant reduction in vascularization and in cork screw vessels could be found in both groups (P < 0.0001, 7 days to last 5-FU), yet there was no difference between the two groups at the last follow-up. Postoperative complications were significantly higher for both groups when more 5-FU injections were applied. (P = 0.008). No significant difference in best corrected visual acuity (P = 0.852) and visual field testing (P = 0.610) between preoperative to last follow-up could be found between the two groups.
  
  
  CONCLUSIONS
  The postoperative injection of bevacizumab reduced the number of subconjunctival 5-FU injections significantly by 2.4 injections. A significant difference in postoperative IOP reduction, bleb morphology, and postoperative medication was not detected.
authors.affiliation: Department of Ophthalmology, Julius Maximilian University, Wuerzburg, Germany.
authors.forename: Florentina Joyce
authors.initials: FJ
authors.lastname: Freiberg
authors.forename: Juliane
authors.initials: J
authors.lastname: Matlach
authors.forename: Franz
authors.initials: F
authors.lastname: Grehn
authors.forename: Sabine
authors.initials: S
authors.lastname: Karl
authors.forename: Thomas
authors.initials: T
authors.lastname: Klink
keywords: 5-fluorouracil; bevacizumab; bleb failure; bleb scarring; glaucoma; trabeculectomy